From Minnesota, USA:
I read with interest your comments about mixing Regular and Humalog. I spoke to our son's endocrinologists. Their reply to me was that it would make it very difficult to adjust Humalog or Regular for tighter control. I would like to know how often you have used this protocol, and how you use the two together.
Mixing Regular and Humalog is not officially approved by Lilly, but has been used in research protocols by Schade and his group and published in abstract form. I have no formal protocol. It has just been my experience that for many patients Regular takes too long to work and lispro insulin [Humalog®] works too quickly and doesn't last long enough. Also, from what I knew about the long acting action of Regular in some patients (Eli Lilly is now putting in writing that Regular can last up to 16 hours in some people), it just didn't make sense to me that I could just switch unit for unit from Regular to Humalog. When I first started using Humalog, I told patients just to start by omitting 1 unit of Regular at a time and substitute one unit of Humalog at a time (preferably starting at only one meal at a time) to try and see when the 2 insulins were really working. I then suggested that they gradually increase the Humalog and decrease the Regular to see what happens.
My experience has been that some patients can't tolerate any Humalog at all, some do best on all Humalog and no Regular, but the majority do best on a combination of Humalog and Regular. If their regular was working up to 16 hours, they needed to adjust their other insulin/insulins to make up for the decreased amount of regular working 12-16 hours after the injection.
I agree that it is more difficult to use more insulins together, but if you make small changes at a time and figure our when the insulins are actually working, you will come up with your own individual guidelines to figure out how to adjust the insulin. You must of course always remember that whatever insulin regimen you use, there is usually some overlapping of the times of action of the different insulins whether they are given together at the same time or separately at different times. Also, the bigger the dose of any insulin you give, the longer it lasts. The more small doses of insulin you give that are working at different times, the greater your ability to change one insulin at a time to change your blood sugar during a discrete period during the day (whether you give the insulins in separate multiple injections, several insulins together in the same syringe, or using a pump).
I actually have patients mixing Humalog, Regular, Lente, and Ultralente together and giving it twice daily. I wish Semilente insulin were still available. It worked more slowly that Regular and faster than Lente. I'd love to try and add that!
Original posting 6 Oct 97
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